Bolens M, Friedli B
Am J Cardiol. 1984 May 15;53(10):1415-20. doi: 10.1016/s0002-9149(84)90825-7.
Arrhythmias are common in the natural history as well as in the late postoperative course of patients with atrial septal defect (ASD); electrophysiologic disturbances may result from the ASD itself or from surgery. Electrophysiologic studies were performed in 18 children (mean age 10 years) both before and after surgical closure of the ASD. Sinus node (SN) function, conduction intervals and refractory periods (atrial and atrioventricular [AV] nodal) were determined. Before surgery, corrected SN recovery time was prolonged in 14 patients; the mean value for the group was 357 +/- 163 ms. The AH interval was slightly prolonged, as were AV nodal refractory periods. Postoperatively, SN recovery time decreased in all patients who remained in sinus rhythm (p less than 0.02), but 5 patients had atrial ectopic rhythm. The AH interval decreased significantly (p less than 0.02), as did the refractory periods, mainly for the AV node (p less than 0.01). The pacing rate at which second-degree AV block occurred increased. Thus, closure of ASD improves AV conduction, decreases AV nodal refractory periods and improves SN function, probably by suppressing rightsided heart volume overload. However, SN function may be lost, probably as a result of the operative procedure.
心律失常在房间隔缺损（ASD）患者的自然病程以及术后晚期病程中都很常见；电生理紊乱可能由ASD本身或手术引起。对18名儿童（平均年龄10岁）在ASD手术闭合前后均进行了电生理研究。测定了窦房结（SN）功能、传导间期和不应期（心房和房室[AV]结）。手术前，14例患者的校正窦房结恢复时间延长；该组的平均值为357±163毫秒。AH间期略有延长，房室结不应期也延长。术后，所有仍保持窦性心律的患者窦房结恢复时间均缩短（p<0.02），但有5例患者出现房性异位心律。AH间期显著缩短（p<0.02），不应期也缩短，主要是房室结（p<0.01）。发生二度房室传导阻滞时的起搏频率增加。因此，ASD闭合可改善房室传导，缩短房室结不应期并改善窦房结功能，可能是通过抑制右心容量超负荷实现的。然而，窦房结功能可能丧失，可能是手术操作的结果。
